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Client#: 25320 <br />KIMLHORN <br />ACORDTM CERTIFICATE OF LIABILITY INSURANCE <br />PAEfMMIODN Y <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />ta/2o1s <br />a128/2016 <br />THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL tNSURED, the pollcy(ieS) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder In lieu of such andorsement(s). <br />PRODUCER <br />E�Clf <br />C Jerry Noyola <br />Grayling Ins. Brokerage/EPIC <br />FAX <br />P SNE 770.552-4225 - <br />aic N e Ext : INC,wg): 866.5504082 <br />3780 Mansell Road, Suite 370 <br />EAiL --- <br />ADDRESS: jerry.noyola@greyling.com__� <br />Alpharetta, GA 30022 <br />0410112017 <br />877 908-5619 <br />INSURER(S) AFFORDING COVERAGE NAIL# <br />INSURER A: National Union Fire Ins. Co. 19445 <br />X Contractual Liab. <br />INSURES <br />INSURERS: Commerce & Industry Ins. Co. 19410 <br />Klm_ <br />-Horn and Associates, Inc. <br />INSURER c: New Hampshire Ins, Co. 23841 <br />- - <br />P.O. B <br />P.O. Box 33068 <br />INSURER D: Lloyds of London 085202 <br />Raleigh, NC 27636 <br />PERSONAL&ADV INJURY $1000000 <br />INSURER E: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 16.17 REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID <br />LTRR <br />TYPEOFINSURANCE <br />ASDLI9UB <br />POLICY NUMBER <br />/AMI IC EF <br />��A�gII VDv EEC%XLLpAIMS, <br />MM/ODfY"YYY <br />LIMITS <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE 7X OCCUR <br />'5268169 <br />4!01/2016 <br />0410112017 <br />EEAAqCM�HHq�OOEECrCTURRpRENCE $1000000 <br />RREMISES Ea oxTurd n $500 000 <br />X Contractual Liab. <br />MED EXP Anyone person 525,000 <br />_ <br />PERSONAL&ADV INJURY $1000000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY ®JECOT i� LOO <br />GENERALAGGREGATE52L000,000 <br />PRODUCTS -s2000000 <br />52 000,000 <br />OTHER'. <br />$ <br />A <br />AUTOMOBILE <br />LIABILITY <br />4489663 <br />4/01/2016 <br />04/01/201 <br />OMBINEDSINGLE LIMIT <br />Ea acoMepO 1,OOQOOD <br />BODILY INJURY( Per Person) $ <br />X <br />ANY AUTO <br />X <br />ALL OWNED SCHEOULEO <br />11T"AUTOB <br />NON�OWNEDTO <br />HIRED AUTOS XAUS <br />BODILY INJURY (Por accitlenq $ <br />PROPERTY DAMAGE $ <br />Per acct enl __ .,_ <br />B <br />)( <br />UMBRELLA LIAR <br />X occuR <br />BE013778306 <br />4/01!2016 <br />04/011201 <br />EACH OCCURRENCE $5 OQQ OOO <br />_ <br />AGGREGATE'$5,000,000 <br />E%GESSLIAB _ <br />CLAIMS -MADE <br />OED I X RETENTION$1D 000 <br />$ <br />! <br />C <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN + <br />15893685 AOS <br />(ADS) <br />4101/2016 <br />Q4/01I2O1 <br />X PER DTH - <br />- <br />E.L.EACH ACCIDENT $1 OOOOOO <br />A <br />ANYPppDPgqIETORIPARTNERfEEXECUTIVE <br />OFFICERPMEMBER EXCLUDEU9 N <br />(Mantlatory In MH) �' <br />NIA <br />15893666 (CA) <br />4/0112016 <br />04/01/201 <br />_ <br />E.L. DISEASE EA EMPLOYEE $1,000 DOD <br />DIf ESCRIPTION OF OPERATIONS below <br />E.L. DISEASE POLICY LIMIT $1,000,000 <br />D <br />Professional Liab <br />Pp70631600 <br />4/01/2016 <br />04/01/201 <br />per Claim $2,000,000 <br />Aggregto $2,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101, Additional Remarks Schedule, may bo attached fl more space is required) <br />Re: City of Santa Ana On -Call Environmental Projects. The City of Santa Ana, its officers, employees, <br />agents, volunteers & representatives are named as Additional Insureds with respects to General Liability <br />where required by written contract. The above referenced liability policies with the exception of <br />professional liability are primary & non-contributory where required by written contract. Should any of the <br />above described policies be cancelled by the issuing insurer before the expiration date thereof, 30 da s' <br />(See Attached Descriptions) Qt�4� I _ /y <br />City of Santa Ana <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS, <br />AUTHORIZED REPRESENTATIVE <br />ACDRn Cr1RPnPATNYM All H.Ihfe mmn.nN <br />ACORD 25 (2014101) 1 Of 2 The ACORD name and logo are registered marks of ACORD <br />NS461941IM461305 CUND1 <br />